reza habibisaravi

Emergency medical services (EMS) play a crucial role as the first line of defense during emergencies and disasters. Given the current impact of climate change, EMS will need to employ innovative strategies to cope with changing conditions. This scoping review investigates how EMS can adapt to climate change in pre-hospital emergencies.

In this study, peer-reviewed studies and texts on adaptive strategies of pre-hospital emergency systems published in 2023 were reviewed. Accordingly, online databases, including Web of Science, PubMed, Scopus, and Google Scholar as a search engine were searched. The selected keywords were as follows: “Medical technician,” “paramedic,” “ambulance,” “climate change,” “global warming,” “adaptation,” “mitigation,” and “resiliency” (and synonyms).

No wide-ranging study has been conducted on the adaptation strategies of EMS against climate change and this is the first study in this field. In this study, elements and adaptation strategies against climate change were investigated. Extracting these cases and using them to improve the readiness and resilience of the pre-hospital emergency system will be effective against this phenomenon.

The COVID-19 epidemic was a biological disaster that may cause or exacerbate burnout in healthcare professionals (HCPs). Our goal was to determine the impact of the long-term COVID-19 epidemic on burnout in front-line healthcare workers and the factors affecting it.

This cross-sectional survey on front-line HCPs’ job burnout based on an online platform was conducted at Mazandaran University of Medical Sciences. The demographic characteristics, medical-work-related factors, and COVID-19 exposure were collected by the self-reported Farsi version of the Maslach burnout inventory questionnaire.

Out of 2100 sent questionnaires, 924 participants completed them (44% response rate) of which 280 were male (30.3%). Overall, 850(92%) respondents had a high level of emotional exhaustion, 872(94.4%) had a high level of depersonalization, and 112(12.1%) had a high reduced personal accomplishment. There was a significant relation between higher burnout levels with higher education levels, working in hospitals as clinical staff, and pre-hospital operational personnel as well as having direct contact with a significant number of COVID-19 Patients. A significant number of participants (94.2%) were in severe and moderate burnout levels.

There was a significant increase in job burnout among front-line HCPs during the COVID-19 epidemic compared to former similar studies at the beginning of the epidemic and non-epidemic periods. It is recommended that in disaster management planning, especially in long-standing ones like COVID-19, the proper programs should be considered for increasing the resilience of HCPs.

Multiple Sclerosis (MS) patients experience a variety of disease caused disabilities that makes them more vulnerable to the effects of disasters. This study aimed to review all existed studies about disasters and related disaster management planning about MS patients.

The PubMed, Google Scholar, Scopus, and Web of Science, ProQuest, science direct , and grey literature databases were searched up to the mid of 2021. All obtained titles were assessed by the inclusion criteria. Abstracts of the relevant titles were reviewed and eligible articles/documents were included for full text review and data abstraction.

From 24616 Articles/documents, finally 15 documents (13 articles, and 2 books) were selected. In 8 articles (53%) specifically, focused on MS patients and, in the rest focused on them as a member of people with disabilities. Most studies (10, 71.4%), emphasized on the disaster induced stress effect on MS patients. In two books/book sections, the disaster preparedness plan for all types of disabilities was presented in general, and MS patients were mentioned as a member of the group of patients with disabilities.

Despite the importance of planning in response to disasters to address specific problems of MS patients, there is a lack of proper planning. This is very important and there is an urgent need to develop appropriate planning protocols for addressing the special conditions of MS patients in response to disasters.

 Several studies have been conducted on the effects of floods on the health of the affected community. We aimed to determine the effects of floods as the most common disaster on hypertension (HTN) as one of the most common noncommunicable diseases (NCDs).

Four databases including Medline, Scopus, Google Scholar, and ScienceDirect were searched with the search strategy protocol up to the end of June 2021 and with the keywords of flood and high blood pressure or hypertension. Grey literature database and websites of WHO, UNDRR, and PreventionWeb were also searched. After removing duplicate articles, abstracts of the relevant titles were reviewed, and eligible articles were included for full-text review. Finally, the study variables were extracted from selected articles.

The search strategy resulted in eight final relevant articles from 48,980 articles. All final articles noted meaningful effect of flood on high blood pressure. There was a positive correlation between anxiety level, property loss, financial loss, physical activity, use of alcoholic beverages, interruption of medication, and medical cares with HTN. Different studies have also reported long-term effects of flooding on blood pressure.

The flood has significant effect on high blood pressure in affected population. However, cases of unknown HTN in the affected population should also be considered, so screening is recommended in the affected community

The ability to respond to any emergency before happening is a potential issue that manifests as operational readiness. This study aimed to evaluate the preparedness of prehospital emergency services of Mazandaran University of Medical Sciences in response to the epidemic of COVID-19.

This cross-sectional study was performed in April 2020 using a translated standard checklist of the Pan American World Health Organization (PAHO). The list consists of four components of call management (6 items), first responders (operational codes with 3 items), medical transportation (including primary and interhospital with 16 items), and emergency medical services administration (including medical guidelines, human resources, and education with 11 items).

There were 168 operational logistics facilities and 555 personnel to cover organizational missions. Except for two items that scored half a point, the rest of the measures received total points (35 out of a maximum of 36 points with 97% of the total points). According to the complete scores, operational readiness was at a good level.

The preparedness of the Center for Disaster Management and Medical Emergencies at Mazandaran University of Medical Sciences in the face of the COVID-19 epidemic has been at a good level. However, because of the continuation of the epidemic, strengthening the supply chain and empowering personnel are essential to sustainable readiness.

Hospitals are one of the vital pillars of the health system. Hospital preparedness in epidemics is a dynamic, complex and multidimensional process that shows the developed capacities and capabilities of the hospital in predicting, reducing the effects, resistance, response, and recovery in the face of biological events. The aim of this study was to investigate the readiness of hospitals in response to the pandemic of COVID-19 disease in Mazandaran province, Iran.

This cross-sectional study was performed in April 2020 using the standard checklist of the Pan American World Health Organization (PAHO 2019). The checklist consists of ten components: incident management system (7 items), coordination (2 items), information management (2 items), logistics (7 items), finance and administration (1item), detection (3 items), diagnosis (3 items), isolation (3 items), cases management (4 items), and prevention and infection control (10 items). Data were analyzed applying Kruskal-Wallis test in SPSS V18.

We studied 39 hospitals in the province, including university hospitals (n=26), social security hospitals (n=4), and private hospitals (n=9). Social security hospitals showed the highest level of readiness (mean score= 82 out of 84), university hospitals had moderate level of readiness (mean score= 72.72 out of 84), and private hospitals had the lowest mean score for readiness (72.5 out of 84). According to the total scores, operational readiness was at a good level.

The readiness of the hospitals in the face of the COVID-19 pandemic was at a good level in Mazandaran province. However, due to the prolonged pandemic and uncertainty about when it comes to an end, monitoring the key components is essential to maintain high level of preparation.

After presenting the novel coronavirus (SARS-CoV-2) in china, it has spread rapidly in the community and now has declared as a pandemic causing coronavirus disease 2019 (COVID-19). At the date of writing this report, the COVID-19 has affected 192 countries and one international conveyance (the Diamond Princess cruise ship harbored in Yokohama, Japan) around the world with the total cases of 341,529. In Iran, the emergence of the disease was reported with two cases of COVID-19 deaths in Qom city on February 19, 2020, that caused great concern for the health system and the general public. It was rapidly spread around the country and reach to 21,638 definite cases by March 22, 2020. The special nature of the disease in rapid transmission among individuals in society requires urgent measures and serious actions to control it as quickly as possible. In this report, we describe the current status of the COVID-19 response strategy for reducing transmission in public and patient load in hospitals in Iran. Although Iran has tried to use the successful experience of other countries, such as China, for various reasons, such as non-quarantine of Qom province, as the primary site of disease propagation, lack of public quarantine, lack of seriousness by some citizens and officials, the lack of facilities and personal protective equipment needed for staff use, and restrictions regarding purchasing equipment from other countries due to international sanctions, have served as obstacles to achieve good results.

Communicable diseases are one of the main health problems in Iran. This study aimed at demonstrating the progress of communicable diseases management in more than 30 years of its implementation and pointing out its strengths and weaknesses, as well.

This interview-based study using content analysis method was conducted in 2014. Data were collected through deep interviews. Fifteen interviews were conducted with all experts and health system managers at Iran’s communicable diseases management center. The collected data were analyzed using the principles suggested by Strauss and Corbin. 

The establishment of the communicable disease surveillance system was a revolution in the health system of Iran. The strengths of the system are as follows: network-based and integrated health services, well-organized and knowledgeable personnel, national and international supports, strategic and operational plans, and expanded programs of immunization. On the other hand, its weaknesses mentioned by the participants were: disease-based case definition, poor public awareness, poor inter-sectoral collaboration and coordination, insufficient resources, delayed or no notifying target diseases, lack of district laws or incomplete implementation of legislation, failure to provide feedback or ignoring for the results of the analysis, and lack of performance evaluation.

Although the implementation of the communicable diseases surveillance system was a huge achievement in the health system of Iran, however, it needs more improvements based on the present situation. Revision of the rules, restoration and strengthening of the existing structure, the use of modern information and communication technologies, and the establishment of the monitoring and evaluation system are helpful to increase its success.

Iran is a country with a high rate of natural disasters like earthquake. The environmental conditions slow down the delivery of health services, especially in the event of disasters. The modern technologies such as telemedicine are appropriate for facilitating disaster relief operations after an earthquake. This study aimed to develop a model for the implementation of telemedicine in an earthquake. The study was carried out using a mixed-methods research in three phases: 1. review of the literature; 2. qualitative study (modeling); and 3. Delphi method (validation of the model). Databases of Google Scholar, Web of Science, Scopus, and PubMed were searched from 1990 to 2019 with the keywords of “telemedicine” AND “disaster” OR “emergency” AND “earthquake”. After screening of the retrieved records, 13 articles met the eligibility criteria and were included in the review study. Ten experts extracted all key elements of telemedicine in the disaster from the articles and categorized them in 6 themes with 38 subthemes. The model of telemedicine in the earthquake was finalized with 2 rounds of Delphi with groups of selected volunteer experts.  In the first phase of the study, 6 key themes (telecommunication infrastructure, technical infrastructure, financial infrastructure, health infrastructure, organizational infrastructure, social infrastructure, and cultural infrastructure) with 38 subthemes of telemedicine for implementing in the disaster were obtained. At the conclusion of the third phase of the study, 6 key themes with 33 subthemes contributed to the model of telemedicine in the earthquake. Telecommunication infrastructure with a maximum score of 9.24 earned the priority, and social and cultural infrastructure themes with the minimum score of 7.53 came in the end. The model derived from this study can be used as an applied telemedicine model in an earthquake. We suggest that the results of this study be implemented as a theoretical model, or in a pilot study in a region of the country, and to be evaluated by regarding mortality reduction. We also recommend that a comparative study for using telemedicine in other types of disasters be undertaken.

While substance abuse among psychiatric patients is a widely known problem in clinical practice, there is no local study about prevalence and co-occurrence of substance abuse in north of Iran. The present study was designed to determine the frequency of smoking, alcohol, opioid and cannabinoid substances, and prescription medicines abuse or dependence among Psychiatric Inpatients. Patients and A cross-sectional 2-year case register study was conducted on all (n = 492) psychiatric inpatients of Zare Psychiatric Hospital in Sari located in north of Iran. The data were obtained by using a standardized and validated questionnaire that contained demographic information along with information on co-morbid psychiatric problems and alcohol, cannabinoids, opioids, and cigarette usage. The mean (± SD) age of samples was 39.9 (± 11.9) years and male:female ratio was 3.6. Opium with or without using other illicit substances was the most frequently abused substance (67%). Significant association were found between illicit substance abuse and demographic variables of male gender, a low level of literacy, living in the urban area, unemployment, cigarette smoking, and young age. There were statistically significant association between schizophrenia and substance abuse (P < 0.001). High prevalence of dual diagnosis warrants attention to the management of substance misuse while treating mental disorders, and should be incorporated in the holistic treatment plan of psychiatric inpatients.

According to the official statistics, cardiac arrest and accidents are included respectively as the first and second causes of death in Iran. Giving first aid to victims by trained people present at the scene causes less damage to the injured. This research was performed in order to study the current state of knowledge and attitudes of staffs of Mazandaran University of Medical Sciences about first aid and CPR. In this descriptive survey, all non-medical staffs (in headquarter and subordinate units) of Mazandaran University of Medical Sciences were studied in city of Sari in 2012. A total of 320 persons were selected and studied with stratified sampling using Cochran formula. By using a self-administered standardized questionnaire, data was collected in three parts: demographic information, knowledge and attitudes assessment. In order to evaluate validity and reliability, it was used of the opinion of public education experts of Red Crescent society and also university professors. However, the results of Cronbach's alpha coefficient (questions related to knowledge and attitudes r=0/83 and r=0/88 respectively) showed an acceptable internal consistency. The comparison of average score between the two groups indicated there were significant differences between the trained and untrained groups about knowledge of first aid (P<0/05, t=2/535). However, significant differences were not observed between attitudes of two groups’ average score towards first aid (0/05< P, t=0/618). According to the results, Mazandaran University of Medical Sciences as one of the monitoring system and responsible organization for promoting health should improve the knowledge and awareness of its personnel. Since the staffs’ information should keep up to date with appropriate retraining methods, appropriate educational programs should be launched for nonmedical staffs of the university. In this regard, one of the most important measures for officials is to pay more attention to promoting and training of first aid skills of the personnel.

Multiple sclerosis (MS) is an autoimmune multifactorial degenerative disease with detrimental affliction on central nervous system. MHC class I chain- related geneA,B(MICA and MICB) are nonclassical human leukocyte antigens that can affect on some diseases and also on transplantation. The purpose of this study was to evaluate the MICA and MICB MRNA expression in multiple sclerosis patients. In this study, we evaluated MICA and MICB MRNA expression in the peripheral blood mononuclear cells by reverse transcryptase-polymerase chain reaction(RT-PCR) in MS patients and normal controls. The results of this study showed that 32.6% of patients with progressive clinical outcome over expressed MICB genes in comparison with controls (p=0.002). It is concluded that the high expression of MICB gene in MS patients is an important criterion of MS disease that it may be due to the interaction between MICB and its receptor on CD8+T or NK cells.